Over the last years, Child and Adolescent Psychiatry services are confronted with a growing number of children and adolescents with severe and enduring mental health problems. Unfortunately, state of the art psychotherapeutic and pharmacological interventions are insufficient to help them. Also, a substantial number of youths drop out of treatment, often due to relational factors with the therapist [1]. Subsequently, a number of youths lose perspective and feel abandoned by society and do not believe that they can be helped. Therefore, innovative ways of providing care must be explored.
In that perspective, we need to explore the possibilities of the growing body of youth peer support workers (YPSWs) in child and adolescent psychiatry (CAP). Youth peer support workers (YPSWs) are (former) CAP patients who support young people with comparable experiences [2]. The involvement of YPSWs in treatment, policy and research may add substantially to the care of young patients with (multiple) psychiatric problems. YPSWs place value on patient autonomy, culturally and developmentally appropriate support, equality, and helping patients find personal meaning and moving on after having lived through (mental) distress [2, 3, 4]. In doing so, YPSWs likely lead the way forward towards more patient-centered and recovery-oriented practice [2].
While the youth peer support workforce can pave the way forward in CAP, the structural involvement of YPSWs remains challenging. The integration of YPSWs can be challenging as the authentic and alternative nature of YPSWs may disrupt current practice commonly promoted by professionals in CAP. A practice predominantly focused on the medical deficit model, whereby treatment is solely evidence-based and a hierarchical structure exists in favor of a clinical or medical background [2, 5] likely hinders the integration of YPSWs in care. It is therefore needed that child psychiatry practice creates the necessary conditions to welcome YPSWs.
In order to integrate YPSWs with medically-oriented practice, a number of researchers and practitioners have made an effort to include YPSWs by identifying replicable elements, and by having YPSWs enact clinical functions [6]. Positive results have been described, such as the ability of YPSWs to help individuals cope with mental illness [2, 3, 6].
A crucial issue for experiencing above mentioned advantages of integrating YPSWs includes giving them the position they need. Approaching YPSWs as a species of mental health worker, restricts YPSWs in their values, diversity and authenticity [6]. More investment in context-specific research is needed to capture how we can encourage YPSWs to bring their expertise and values to different practices; and to understand how the authentic, (non-judgmental) relational aspects, and values underpinning youth peer support might offer something different, and potentially more valuable to CAP [2, 6].
Therefore, the ESCAP Policy Division asks researchers and practitioners in CAP to invest in the potential value of YPSWs. We must integrate existing evidence base with innovative alternative ways of supporting youths with severe mental health problems. Because YPSWs promise to advance the most disordered, there is an urgent need to continue to identify replicable elements in order to standardize youth peer support. We applaud all professionals in CAP who continue to involve and collaborate with YPSWs in practice and research. In order to embed YPSWs structurally in treatment, research efforts should focus on its added value in treatment, and on how to implement YPSW in current practice. Finally, policy legitimizing YPSWs and structural investment is required to advance research and practice on youth peer support.
Authors: de Beer CRM, van Tilburg K and Vermeiren R on behalf of the ESCAP Policy Division and Board
References:
1. de Soet, R. Vermeiren R.R.J.M., Bansema, C.H., van Ewijk, H., Nijland L. & Nooteboom, L.A. (2023). Drop-out and ineffective treatment in youth with severe and enduring mental health problems: a systematic review. European Child & Adolescent Psychiatry
2. de Beer, C. R. M., Nooteboom, L. A., van Domburgh, L., de Vreugd, M., Schoones, J. W., & Vermeiren, R. R. J. M. (2022). A systematic review exploring youth peer support for young people with mental health problems. European Child & Adolescent Psychiatry, 1-14.
3. Walker, J.S., Baird, C., & Welch, M.-B. (2018). Peer Support for Youth and Young Adults who Experience Serious Mental Health Conditions: State of the Science. Portland, OR: Research and Training Center for Pathways to Positive Futures, Portland State University.
4. Krane, V., Sommer, M., Kippenes, M., & Karlsson, B. (2022). ‘It’s like there’s no staff here–we’re all a friendly bunch of people’–Young service users’ experiences of peer support in a youth-friendly service. Nordisk Välfärdsforskning| Nordic Welfare Research, 7(2), 121-132.
5. Mirbahaeddin E, Chreim S (2022) A narrative review of factors influencing peer support role implementation in mental health systems: implications for research, policy and practice. Admin Policy Mental Health 49:1–17
6. Gillard, S. (2019). Peer support in mental health services: where is the research taking us, and do we want to go there? Journal of Mental Health, 28(4), 341-344.
Published: 14 June 2023
